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Laurenti, Ruy
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[PMID]:29211204
[Au] Autor:Kale PL; Jorge MHPM; Laurenti R; Fonseca SC; Silva KSD
[Ad] Endereço:Universidade Federal do Rio de Janeiro. Instituto de Estudos em Saúde Coletiva. Área de Epidemiologia e Bioestatística. Rio de Janeiro, RJ, Brasil.
[Ti] Título:Pragmatic criteria of the definition of neonatal near miss: a comparative study.
[So] Source:Rev Saude Publica;51:111, 2017 Dec 04.
[Is] ISSN:1518-8787
[Cp] País de publicação:Brazil
[La] Idioma:eng; por
[Ab] Resumo:OBJECTIVE: The objective of this study was to test the validity of the pragmatic criteria of the definitions of neonatal near miss, extending them throughout the infant period, and to estimate the indicators of perinatal care in public maternity hospitals. METHODS: A cohort of live births from six maternity hospitals in the municipalities of São Paulo, Niterói, and Rio de Janeiro, Brazil, was carried out in 2011. We carried out interviews and checked prenatal cards and medical records. We compared the pragmatic criteria (birth weight, gestational age, and 5' Apgar score) of the definitions of near miss of Pileggi et al., Pileggi-Castro et al., Souza et al., and Silva et al. We calculated sensitivity, specificity (gold standard: infant mortality), percentage of deaths among newborns with life-threatening conditions, and rates of near miss, mortality, and severe outcomes per 1,000 live births. RESULTS: A total 7,315 newborns were analyzed (completeness of information > 99%). The sensitivity of the definition of Pileggi-Castro et al. was higher, resulting in a higher number of cases of near miss, Souza et al. presented lower value, and Pileggi et al. and de Silva et al. presented intermediate values. There is an increase in sensitivity when the period goes from 0-6 to 0-27 days, and there is a decrease when it goes to 0-364 days. Specificities were high (≥ 97%) and above sensitivities (54% to 77%). One maternity hospital in São Paulo and one in Niterói presented, respectively, the lowest and highest rates of infant mortality, near miss, and frequency of births with life-threatening conditions, regardless of the definition. CONCLUSIONS: The definitions of near miss based exclusively on pragmatic criteria are valid and can be used for monitoring purposes. Based on the perinatal literature, the cutoff points adopted by Silva et al. were more appropriate. Periodic studies could apply a more complete definition, incorporating clinical, laboratory, and management criteria, including congenital anomalies predictive of infant mortality.
[Mh] Termos MeSH primário: Mortalidade Infantil
Nascimento Vivo
Near Miss/estatística & dados numéricos
Assistência Perinatal/estatística & dados numéricos
Morte Perinatal
[Mh] Termos MeSH secundário: Índice de Apgar
Peso ao Nascer
Brasil
Estudos Transversais
Maternidades/estatística & dados numéricos
Seres Humanos
Lactente
Recém-Nascido
Entrevistas como Assunto
Assistência Perinatal/normas
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; VALIDATION STUDIES
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171220
[Lr] Data última revisão:
171220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171207
[St] Status:MEDLINE


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[PMID]:29095291
[Au] Autor:Alshweki A; Pérez-Muñuzuri A; López-Suárez O; Baña A; Couce ML
[Ad] Endereço:Neonatal Unit, Department of Pediatrics, Santiago de Compostela University Hospital, IDIS (Health Research Institute of Santiago de Compostela), CIBERER, Travesia Choupana, Santiago de Compostela, Spain.
[Ti] Título:Relevance of urinary S100B protein levels as a short-term prognostic biomarker in asphyxiated infants treated with hypothermia.
[So] Source:Medicine (Baltimore);96(44):e8453, 2017 Nov.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The initial diagnosis of neonatal hypoxic-ischemic encephalopathy is based on nervous system clinical manifestations. The use of biomarkers to monitor brain injury and evaluate neuroprotective effects allows early intervention and treatment. This study was designed to determine the short-term prognostic significance of urinary S100B calcium-binding protein (S100B) in asphyxiated newborns treated with hypothermia.An observational prospective study was conducted over a period of 5 years in 31 newborns with hypoxic-ischemic encephalopathy who received therapeutic hypothermia. The patients were divided into 2 groups: Group A (13 newborns with a normal neurological examination before discharge) and Group B (18 newborns who died during admission or had an abnormal neurologic examination before discharge). Urinary S100B was the main variable, serum S100B and neuron-specific enolase (NSE) were considered as secondary variables, and all of them were assessed on the first 3 days of life. The newborns were subsequently divided into groups with normal and abnormal electrophysiological and imaging findings.Mean urinary S100B levels were significantly higher in group B than group A on day 1 (10.58 ±â€Š14.82 vs 4.65 ±â€Š9.16 µg/L, P = .031) and day 2 (5.16 ±â€Š7.63 vs 0.88 ±â€Š2.53, P = .002). The optimal cutoff for urinary S100B on day 1 was >1.11 µg/L of (sensitivity, 100%; specificity 60%) for the prediction of neonatal death and < 0.66 µg/L (sensitivity 83% and specificity 70%) for the prediction of a normal neurological examination before discharge. It was not possible to calculate cutoffs with a similar accuracy for serum S100B or NSE. Urinary S100B on day 1 was higher in patients with abnormal magnetic resonance imaging findings (7.89 ±â€Š8.09 vs 4.49 ±â€Š9.14, P = .039) and abnormal positron emission tomography findings (8.60 ±â€Š9.29 vs 4.30 ±â€Š8.28, P = .038). There were no significant differences in S100B levels between patients with normal and abnormal electroencephalography results.Urinary S100B measured in the first days of life can predict neonatal death and short-term prognosis in asphyxiated newborns treated with hypothermia. The method is convenient, noninvasive, and has a higher sensitivity and specificity than measurement of serum S100B or NSE.
[Mh] Termos MeSH primário: Hipotermia Induzida/métodos
Hipóxia-Isquemia Encefálica/urina
Subunidade beta da Proteína Ligante de Cálcio S100/urina
[Mh] Termos MeSH secundário: Biomarcadores/sangue
Biomarcadores/urina
Eletroencefalografia
Feminino
Seres Humanos
Hipóxia-Isquemia Encefálica/sangue
Hipóxia-Isquemia Encefálica/terapia
Recém-Nascido
Masculino
Exame Neurológico/métodos
Morte Perinatal/etiologia
Fosfopiruvato Hidratase/sangue
Prognóstico
Estudos Prospectivos
Subunidade beta da Proteína Ligante de Cálcio S100/sangue
Sensibilidade e Especificidade
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Biomarkers); 0 (S100 Calcium Binding Protein beta Subunit); 0 (S100B protein, human); EC 4.2.1.11 (Phosphopyruvate Hydratase)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171109
[Lr] Data última revisão:
171109
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171103
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008453


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[PMID]:28863151
[Au] Autor:Kc S; Hemminki E; Gissler M; Virtanen SM; Klemetti R
[Ad] Endereço:School of Social Sciences, University of Tampere, Tampere, Finland.
[Ti] Título:Perinatal outcomes after induced termination of pregnancy by methods: A nationwide register-based study of first births in Finland 1996-2013.
[So] Source:PLoS One;12(9):e0184078, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Women with previous terminations of pregnancy (TOPs) before their first birth have been associated with poorer perinatal outcomes. However, previous studies on the perinatal outcomes by the method in previous TOPs are inconsistent. OBJECTIVE: To examine the perinatal outcomes of the first-time mothers with singleton births, by the method of previous TOP (medical and surgical vs no TOP, and surgical vs medical). METHOD: This is a nationwide register-based study including 419,879 first-time Finnish mothers with singleton birth during the time period 1996-2013. Mothers having their first birth were identified from the Medical Birth Register and linked to the Abortion Register by their identification numbers. Multinomial logistic regression analysis was performed to examine the risk for preterm birth, low birth weight, small for gestational age and perinatal death by the method in previous TOPs. RESULTS: Among the first-time mothers, 87.0% had no history of TOPs, 3.2% had a history of medical TOP(s), 9.2% had a history of surgical TOP(s) and 0.6% had a history of both (medical and surgical) TOP(s). No significant differences in perinatal outcomes were found among the women with surgical TOPs, compared to the women with no TOPs. In unadjusted analysis, increased odds for preterm birth and low birth weight were found when comparing women having previous surgical TOPs with medical TOPs. Even after the adjustment of potential confounders, odds for preterm birth < 37 weeks (OR = 1.19, 95% CI = 1.04-1.36) and low birth weight < 2500 g (OR = 1.16, 95% CI = 1.00-1.35) remained significant. After restricting data to the single TOP, the results were similar; OR for both preterm birth and low birth weight was 1.18 (95% CIs = 1.02-1.36 and 1.01-1.38). CONCLUSION: Perinatal outcomes did not differ among the mothers with surgical TOPs compared to the mothers with no TOPs, while the outcomes were poorer after surgical TOP(s) than after medical TOP(s).
[Mh] Termos MeSH primário: Aborto Induzido/efeitos adversos
Complicações na Gravidez/epidemiologia
[Mh] Termos MeSH secundário: Aborto Induzido/métodos
Adolescente
Adulto
Feminino
Finlândia
Idade Gestacional
Seres Humanos
Recém-Nascido de Baixo Peso
Recém-Nascido
Recém-Nascido Prematuro
Recém-Nascido Pequeno para a Idade Gestacional
Razão de Chances
Morte Perinatal
Gravidez
Resultado da Gravidez
Nascimento Prematuro
Sistema de Registros
Análise de Regressão
Fatores de Risco
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171023
[Lr] Data última revisão:
171023
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170902
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0184078


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Costa, Maria da Conceiçäo Nascimento
Texto completo SciELO Brasil
Texto completo SciELO Saúde Pública
[PMID]:28832759
[Au] Autor:Nascimento RCS; Costa MDCN; Braga JU; Natividade MSD
[Ad] Endereço:Instituto de Saúde Coletiva. Universidade Federal da Bahia. Salvador, BA, Brasil.
[Ti] Título:Spatial patterns of preventable perinatal mortality in Salvador, Bahia, Brazil.
[So] Source:Rev Saude Publica;51:73, 2017 Aug 17.
[Is] ISSN:1518-8787
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To identify the spatial distribution patterns and areas of higher risk of preventable perinatal mortality in the city of Salvador, State of Bahia, Brazil. METHODS: We carried out a spatial aggregated study in 2007, considering the weighting areas (census tracts contiguous sets) of Salvador, of which the center and north present low life conditions. Data were obtained from national vital statistics systems and the 2010 Census. Addresses of live births and stillbirths were geocoded by weighting area. The spatial distribution of the perinatal mortality rate was analyzed from thematic maps. Spatial dependence was evaluated by the Global and Local Geary's and Moran's Indexes. RESULTS: Crude and smoothed perinatal mortality rates were high in areas situated to the north, west, and in center of Salvador. The smoothed rates in weighting areas ranged from 4.9/1,000 to 22.3/1,000 births. Of all perinatal deaths, 92.1% could have been prevented. We identified spatial dependence for preventable perinatal mortality for care in pregnancy, with neighboring areas with high risk in the north of the city. CONCLUSIONS: The preventability potential of perinatal mortality was high in Salvador, in 2007. The spatial distribution pattern with higher rates in disadvantaged areas of the city suggests the existence of social inequalities in health. The characteristics of the process of urban development of Salvador, which has inadequate prenatal care, possibly influenced the magnitude and spatial distribution pattern of this mortality.
[Mh] Termos MeSH primário: Morte Perinatal/prevenção & controle
Mortalidade Perinatal
Análise Espacial
[Mh] Termos MeSH secundário: Brasil/epidemiologia
Causas de Morte
Parto Obstétrico
Feminino
Seres Humanos
Lactente
Recém-Nascido
Gravidez
Medição de Risco/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170824
[St] Status:MEDLINE


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[PMID]:28760341
[Au] Autor:Okamatsu N; Sakai N; Karakawa A; Kouyama N; Sato Y; Inagaki K; Kiuchi Y; Oguchi K; Negishi-Koga T; Takami M
[Ad] Endereço:Department of Orthopaedic Surgery, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan; Department of Pharmacology, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan; Department of Pharmacology, School of Dentistry, Show
[Ti] Título:Biological effects of anti-RANKL antibody administration in pregnant mice and their newborns.
[So] Source:Biochem Biophys Res Commun;491(3):614-621, 2017 Sep 23.
[Is] ISSN:1090-2104
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Denosumab, a fully human monoclonal antibody that neutralizes receptor activator of nuclear factor-κB ligand (RANKL) and blocks osteoclast differentiation, has received approval in Japan for use as an anti-resorptive drug for osteoporosis and skeletal-related events (SREs) in patients with solid cancer. Denosumab is contraindicated during pregnancy, though the effects of blocking RANKL activity on pregnant mothers and their newborns are unclear. We used mice to investigate the effects of an anti-RANKL antibody on maternal and newborn health. Mothers injected with the anti-RANKL antibody had increased bone mass as compared with the controls, while osteoclast number and the level of tartrate-resistant acid phosphatase (TRAP) in serum were increased at the end of pregnancy. Newborn mice exposed to the antibody in utero were normally born, but showed increased bone mass and died within 48 h after birth. None of the newborns were found to have milk in their stomachs, suggesting that they died due to a maternal defect in lactation. Consistent with this, anti-RANKL antibody-injected mothers displayed impaired mammary gland development. However, fostering by healthy surrogate mothers rescued only 33% of the antibody-exposed newborns, suggesting that neonatal mortality was due, at least in part, to an intrinsic defect in the newborns. Our findings show that anti-RANKL antibody administration during pregnancy results in not only an undesirable increase in bone mass, but also has harmful effects on newborn survival.
[Mh] Termos MeSH primário: Denosumab/efeitos adversos
Transtornos da Nutrição do Lactente/induzido quimicamente
Transtornos da Nutrição do Lactente/imunologia
Transtornos da Lactação/induzido quimicamente
Transtornos da Lactação/imunologia
Morte Perinatal/etiologia
Ligante RANK/imunologia
[Mh] Termos MeSH secundário: Animais
Animais Recém-Nascidos
Conservadores da Densidade Óssea/administração & dosagem
Conservadores da Densidade Óssea/efeitos adversos
Denosumab/administração & dosagem
Denosumab/imunologia
Feminino
Seres Humanos
Recém-Nascido
Masculino
Camundongos
Camundongos Endogâmicos C57BL
Gravidez
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Bone Density Conservation Agents); 0 (RANK Ligand); 0 (Tnfsf11 protein, mouse); 4EQZ6YO2HI (Denosumab)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170911
[Lr] Data última revisão:
170911
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170802
[St] Status:MEDLINE


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[PMID]:28737006
[Au] Autor:Opsjøn BE; Nordbø SA; Vogt C
[Ad] Endereço:Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
[Ti] Título:Unrecognized viral infections and chromosome abnormalities as a cause of fetal death - examination with fluorescence in situ hybridization, immunohistochemistry and polymerase chain reaction.
[So] Source:APMIS;125(9):826-832, 2017 Sep.
[Is] ISSN:1600-0463
[Cp] País de publicação:Denmark
[La] Idioma:eng
[Ab] Resumo:Fifteen to 50% of fetal deaths remain unexplained after post-mortem examination depending on inclusion criteria and classification systems. Our aim was to examine a selection of unexplained fetal deaths in order to investigate whether any common chromosome aberrations or viral infections were present. Reports from 351 fetal autopsies performed at the Department of Pathology and Medical Genetics at St. Olavs University Hospital from 2001 through 2010 were reviewed. Of these, 105 fetal deaths were classified as unexplained. Tissue samples from 30 cases were further examined with fluorescence in situ hybridization (FISH) to detect abnormalities in chromosomes 13, 18, and 21. The samples were also examined with immunohistochemistry (IHC) and polymerase chain reaction (PCR) to detect infections with cytomegalovirus, parvovirus B19, herpes simplex virus 1 and 2, enterovirus, and parechovirus. In two cases, a possible trisomy 13 mosaicism was found. No viruses were detected. In our selection of 30 unexplained cases, possible trisomy 13 mosaicism was found in two cases, and no viruses were detected. High degree of maceration and missing placental examination often complicate the investigation of fetal death, and extensive ancillary examinations do not necessarily contribute to a more specific diagnosis.
[Mh] Termos MeSH primário: Transtornos Cromossômicos/diagnóstico
Morte Fetal/etiologia
Morte Perinatal/etiologia
Complicações Infecciosas na Gravidez/diagnóstico
Trissomia/diagnóstico
Viroses/diagnóstico
[Mh] Termos MeSH secundário: Adolescente
Adulto
Autopsia
Transtornos Cromossômicos/genética
Cromossomos Humanos Par 13/genética
Feminino
Seres Humanos
Imuno-Histoquímica
Hibridização in Situ Fluorescente
Masculino
Reação em Cadeia da Polimerase
Gravidez
Complicações Infecciosas na Gravidez/virologia
Trissomia/genética
Síndrome da Trissomia do Cromossomo 13
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170725
[St] Status:MEDLINE
[do] DOI:10.1111/apm.12726


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[PMID]:28614453
[Au] Autor:Feitoza HAC; Koifman S; Koifman RJ; Saraceni V
[Ad] Endereço:Secretaria Municipal de Saúde de Rio Branco, Rio Branco, Brasil.
[Ti] Título:Dengue infection during pregnancy and adverse maternal, fetal, and infant health outcomes in Rio Branco, Acre State, Brazil, 2007-2012.
[Ti] Título:Os efeitos maternos, fetais e infantis decorrentes da infecção por dengue durante a gestação em Rio Branco, Acre, Brasil, 2007-2012..
[So] Source:Cad Saude Publica;33(5):e00178915, 2017 Jun 12.
[Is] ISSN:1678-4464
[Cp] País de publicação:Brazil
[La] Idioma:por; eng
[Ab] Resumo:The effects of dengue infection during pregnancy have not been previously studied in Rio Branco, Acre State, Brazil. The aim of this study was to determine the risks of maternal, fetal, and infant complications resulting from dengue infection during pregnancy. The study compared two cohorts of pregnant women, exposed versus unexposed to dengue virus, from 2007 to 2012. Incidence rates and risk ratios were estimated for maternal, fetal, and infant complications. In the exposed cohort there were 3 fetal deaths and 5 neonatal deaths. Two maternal deaths were identified in the exposed cohort, as opposed to none in the unexposed group (p = 0.040). The exposed cohort showed a risk ratio (RR) of 3.4 (95%CI: 1.02-11.23) for neonatal death. The risk ratio for early neonatal death was 6.8 (95%CI: 1.61-28.75). Ten infant deaths occurred in children of exposed pregnant women and 7 in unexposed (RR = 6.0; 95%CI: 2.24-15.87). Women infected with dengue virus in pregnancy showed increased risk ratio for maternal, neonatal, and infant mortality.
[Mh] Termos MeSH primário: Dengue/complicações
Dengue/mortalidade
Complicações Infecciosas na Gravidez/mortalidade
Complicações Infecciosas na Gravidez/virologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Brasil/epidemiologia
Estudos de Casos e Controles
Estudos de Coortes
Feminino
Morte Fetal
Seres Humanos
Lactente
Recém-Nascido
Mortalidade Materna
Meia-Idade
Morte Perinatal
Gravidez
Estudos Retrospectivos
Fatores Socioeconômicos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170705
[Lr] Data última revisão:
170705
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170615
[St] Status:MEDLINE


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[PMID]:28604213
[Au] Autor:Evans N
[Ti] Título:Updated perinatal palliative standards emphasise choice and bereavement support.
[So] Source:Nurs Child Young People;29(5):8-9, 2017 Jun 12.
[Is] ISSN:2046-2344
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Ana Todorovic's baby, Nadia, died just before birth. Ana says she received excellent care and was told when 37 weeks pregnant that Nadia was not going to survive for long.
[Mh] Termos MeSH primário: Luto
Cuidados Paliativos/normas
Morte Perinatal
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Recém-Nascido
Enfermagem Neonatal
Cuidados Paliativos/recursos humanos
Guias de Prática Clínica como Assunto
Gravidez
Reino Unido
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170720
[Lr] Data última revisão:
170720
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:170613
[St] Status:MEDLINE
[do] DOI:10.7748/ncyp.29.5.8.s8


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[PMID]:28586127
[Au] Autor:Alfirevic Z; Stampalija T; Medley N
[Ad] Endereço:Department of Women's and Children's Health, The University of Liverpool, First Floor, Liverpool Women's NHS Foundation Trust, Crown Street, Liverpool, UK, L8 7SS.
[Ti] Título:Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy.
[So] Source:Cochrane Database Syst Rev;6:CD008991, 2017 06 06.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Cervical cerclage is a well-known surgical procedure carried out during pregnancy. It involves positioning of a suture (stitch) around the neck of the womb (cervix), aiming to give mechanical support to the cervix and thereby reduce risk of preterm birth. The effectiveness and safety of this procedure remains controversial. This is an update of a review last published in 2012. OBJECTIVES: To assess whether the use of cervical stitch in singleton pregnancy at high risk of pregnancy loss based on woman's history and/or ultrasound finding of 'short cervix' and/or physical exam improves subsequent obstetric care and fetal outcome. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register (30 June 2016) and reference lists of identified studies. SELECTION CRITERIA: We included all randomised trials of cervical suturing in singleton pregnancies. Cervical stitch was carried out when the pregnancy was considered to be of sufficiently high risk due to a woman's history, a finding of short cervix on ultrasound or other indication determined by physical exam. We included any study that compared cerclage with either no treatment or any alternative intervention. We planned to include cluster-randomised studies but not cross-over trials. We excluded quasi-randomised studies. We included studies reported in abstract form only. DATA COLLECTION AND ANALYSIS: Three review authors independently assessed trials for inclusion. Two review authors independently assessed risk of bias and extracted data. We resolved discrepancies by discussion. Data were checked for accuracy. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS: This updated review includes a total of 15 trials (3490 women); three trials were added for this update (152 women). Cerclage versus no cerclageOverall, cerclage probably leads to a reduced risk of perinatal death when compared with no cerclage, although the confidence interval (CI) crosses the line of no effect (RR 0.82, 95% CI 0.65 to 1.04; 10 studies, 2927 women; moderate quality evidence). Considering stillbirths and neonatal deaths separately reduced the numbers of events and sample size. Although the relative effect of cerclage is similar, estimates were less reliable with fewer data and assessed as of low quality (stillbirths RR 0.89, 95% CI 0.45 to 1.75; 5 studies, 1803 women; low quality evidence; neonatal deaths before discharge RR 0.85, 95% CI 0.53 to 1.39; 6 studies, 1714 women; low quality evidence). Serious neonatal morbidity was similar with and without cerclage (RR 0.80, 95% CI 0.55 to 1.18; 6 studies, 883 women; low-quality evidence). Pregnant women with and without cerclage were equally likely to have a baby discharged home healthy (RR 1.02, 95% CI 0.97 to 1.06; 4 studies, 657 women; moderate quality evidence).Pregnant women with cerclage were less likely to have preterm births compared to controls before 37, 34 (average RR 0.77, 95% CI 0.66 to 0.89; 9 studies, 2415 women; high quality evidence) and 28 completed weeks of gestation.Five subgroups based on clinical indication provided data for analysis (history-indicated; short cervix based on one-off ultrasound in high risk women; short cervix found by serial scans in high risk women; physical exam-indicated; and short cervix found on scan in low risk or mixed populations). There were too few trials in these clinical subgroups to make meaningful conclusions and no evidence of differential effects. Cerclage versus progesteroneTwo trials (129 women) compared cerclage to prevention with vaginal progesterone in high risk women with short cervix on ultrasound; these trials were too small to detect reliable, clinically important differences for any review outcome. One included trial compared cerclage with intramuscular progesterone (75 women) which lacked power to detect group differences. History indicated cerclage versus ultrasound indicated cerclageEvidence from two trials (344 women) was too limited to establish differences for clinically important outcomes. AUTHORS' CONCLUSIONS: Cervical cerclage reduces the risk of preterm birth in women at high-risk of preterm birth and probably reduces risk of perinatal deaths. There was no evidence of any differential effect of cerclage based on previous obstetric history or short cervix indications, but data were limited for all clinical groups. The question of whether cerclage is more or less effective than other preventative treatments, particularly vaginal progesterone, remains unanswered.
[Mh] Termos MeSH primário: Cerclagem Cervical/métodos
Nascimento Prematuro/prevenção & controle
[Mh] Termos MeSH secundário: Administração Intravaginal
Cerclagem Cervical/efeitos adversos
Cesárea/utilização
Feminino
Seres Humanos
Injeções Intramusculares
Morte Perinatal/prevenção & controle
Gravidez
Nascimento Prematuro/epidemiologia
Progesterona/administração & dosagem
Ensaios Clínicos Controlados Aleatórios como Assunto
Natimorto/epidemiologia
Técnicas de Sutura
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
4G7DS2Q64Y (Progesterone)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170901
[Lr] Data última revisão:
170901
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170607
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD008991.pub3


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[PMID]:28538795
[Au] Autor:Kale PL; Mello-Jorge MHP; Silva KSD; Fonseca SC
[Ad] Endereço:Instituto de Estudos de Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil.
[Ti] Título:Neonatal near miss and mortality: factors associated with life-threatening conditions in newborns at six public maternity hospitals in Southeast Brazil.
[So] Source:Cad Saude Publica;33(4):e00179115, 2017 May 18.
[Is] ISSN:1678-4464
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:We aimed to evaluate factors associated with cases of neonatal near miss and neonatal deaths at six public maternity hospitals in São Paulo and Rio de Janeiro States, Brazil, in 2011. A prospective hospital-based birth cohort investigated these outcomes among live births with life-threatening conditions. Associations were tested using multinomial logistic regression models with hierarchical levels. High rates of near miss were observed for maternal syphilis (52.2‰ live births) and lack of prenatal care (80.8‰ live births). Maternal black skin color (OR = 1.9; 95%CI: 1.2-3.2), hemorrhage (OR = 2.2; 95%CI: 1.3-3.9), hypertension (OR = 3.0; 95%CI: 2.0-4.4), syphilis (OR = 3.3; 95%CI: 1.5-7.2), lack of prenatal care (OR = 5.6; 95%CI: 2.6-11.7), cesarean section and hospital, were associated with near miss; while hemorrhage (OR = 4.6; 95%CI: 1,8-11.3), lack of prenatal care (OR = 17.4; 95%CI: 6.5-46.8) and hospital, with death. Improvements in access to qualified care for pregnant women and newborns are necessary to reduce neonatal life-threatening conditions.
[Mh] Termos MeSH primário: Mortalidade Infantil
Nascimento Vivo/epidemiologia
Near Miss/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
Brasil/epidemiologia
Feminino
Idade Gestacional
Maternidades
Seres Humanos
Lactente
Recém-Nascido de Baixo Peso
Recém-Nascido
Masculino
Morte Perinatal
Gravidez
Cuidado Pré-Natal
Estudos Prospectivos
Fatores de Risco
Fatores Socioeconômicos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170804
[Lr] Data última revisão:
170804
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170525
[St] Status:MEDLINE



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